Abstract P3-08-23: Prosigna assay for treatment decisions in early breast cancer: A single center, decision impact study

Background: Therapeutic decisions in early breast cancer (EBC) are based on clinical and pathological features, which are subject to intra- and inter-observer variability. Hence, in the era of precision medicine, there is growing need for predictive biomarkers. The Prosigna assay utilizes Prediction Analysis of Microarray, a test based on the analysis of 50 intrinsic subtype-linked gene clusters. This single center decision impact study aimed to evaluate the effect of Prosigna test results on physicians' adjuvant treatment choices.

Methods: Between September 2017 and February 2018, FFPE tumor samples from 53 newly diagnosed, postmenopausal, hormone receptor-positive, HER2-negative EBC (T1-T2; pN0-N1a) patients were analyzed. Pre-test clinical judgments and Prosigna test results were compared.

Results: Mean age was 59 (42-77). Invasive ductal carcinoma (79.2%), grade 2 (52.8%) and T1c-N0 tumors (43.4%) represented the majority. Before the Prosigna test, 65.4% of the patients were classified as luminal A and 34.6% as luminal B. Of the pre-test risk groups, 40.4% were low-risk, 40.4% were intermediate risk and 19.2% were high risk. Prosigna assay grouped 50% of patients as luminal A, 44.2% as luminal B, 3.8% as basal type and 1.9% as HER2-expressing. Post-test ROR score-based groups were distributed as 25% low-risk, 40.4% intermediate risk and 34.6% high risk. There was a statistically significant correlation between clinically defined and molecularly assessed intrinsic BC subtypes (kappa:0.334, p=0.007). Similarly, pre-test and post-test recurrence risk groups were correlated (kappa:0.397, p=0.001). Before the Prosigna test, endocrine treatment was physicians' primary choice in 20 patients (39.2%), chemotherapy was recommended to 31 patients (60.8%). Overall, the Prosigna assay led to a change in choice of treatment for one patient (2%). There was 40.4% discordance between pre- and post-test recurrence risk groups. In addition, intrinsic subtypes were 34.6% discordant, which is largely driven by the reclassification of pre-test luminal A tumors into Prosigna luminal B group.

Table 1.Impact of Prosigna Results on Final Treatment Decision Prosigna low risk N=13 (%24.5)Prosigna intermediate risk N=21 (%39.6)Prosigna high risk N=18 (%34)Total N=51 (%100)Treatment choice before Prosigna    CT+HT0121729 (56.9)HT only127120 (39.2)CT offered, not accepted by the patient0202 (3.9)Treatment choice after Prosigna    CT+HT0121830 (58.8)HT only127019 (37.3)CT offered, not accepted by the patient0202 (3.9)Change in treatment choice    HT to CT001100 (0)CT to HT0000 (0)CT: Chemotherapy HT: Hormonotherapy

Conclusions: Although conventional risk assessment methods are relatively inexpensive with shorter turnaround times, their accuracy for risk assessment and value for risk reduction are suboptimal. According to our results, Prosigna assay was found as a relevant tool for clinical decision-making process. In cases where there is a discrepancy between the clinical assessment results and the Prosigna assay, tumor boards may guide treatment recommendations. Long term follow-up of these patients will elucidate the potential benefits of using multigene molecular tests as biomarkers for EBC treatment.

Citation Format: Esin E, Oksuzoglu BO, Markoc F, Bilgetekin I, Yildiz F, Guntekin S, Yukruk F, Atalay R. Prosigna assay for treatment decisions in early breast cancer: A single center, decision impact study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-08-23.

Granulocytic Sarcomas: Difficulties in Diagnosis

Granulocytic sarcoma is an uncommon tumor composed of myeloid blasts and/or immature myeloid cells in an extramedullary site which is usually associated with acute or chronic myeloid leukemia. The tumor may also be the initial manifestation of leukemia. The histomorphological diagnosis of granulocytic sarcoma can be challenging to pathologists, especially in the absence of a known hematological disorder. In this case, differentiation of granulocytic sarcoma from malignant lymphomas and other small round cell tumors is very critical. Seven cases of granulocytic sarcoma are reported in this paper. One patient had granulocytic sarcomas at two different sites. Hematoxylin-eosin-stained sections were reexamined. Blastic, poorly differentiated, and well differentiated histopathological variants were found in two, five and one cases, respectively. Immunohistochemical studies were performed on formalin-fixed tissue from all cases using a avidin-biotin-peroxidase complex technique. The panel included antibodies against LCA, CD43, CD34, c-kit, myeloperoxidase, CD68 KP1, CD15, and CD99. All cases stained positively with LCA, CD43, CD34, myeloperoxidase, and CD68. Five cases were positive for c-kit, three cases were positive for CD15, and two cases were positive for CD99. An immunohistochemical panel including at least myeloperoxidase, CD68 and CD34 can be used for detection of myeloid differentiation. It is also important that granulocytic sarcoma be considered in the differential diagnosis of CD99-positive round cell tumors.

Evaluation of the effects of omega-3 & interferon alpha-2b administration on partial bladder outlet obstruction in a rat model

BACKGROUND & OBJECTIVES

In bladder outlet obstruction-induced rat models, the transforming growth factor-beta (TGF-β) and collagen ratios have been shown to be increased. Increased TGF-β leads to fibrosis. In this study, the effect of omega-3 and interferon alpha-2b (IFN α-2b) was investigated on oxidative stress, inflammation and fibrosis in bladder structure in a partial bladder outlet obstruction (PBOO) rat model.

METHODS

A total of 35 male Wistar albino rats, weighing 300-350 g, were used in the study. The rats were randomly divided into five groups. At the end of the experimental period, bladders were harvested from all the rats, and pathological analysis of the rat bladder tissues was performed. In addition, investigations were carried out with enzymatic and non-enzymatic antioxidant systems to study the antioxidant properties of omega-3 fatty acid and IFN alpha-2b.

RESULTS

Increased bladder weight in the PBOO group, in comparison to the control group, was decreased by the administration of omega-3 and IFN α-2b (P=0.002). Significantly higher superoxide dismutase (SOD) levels were detected in group 2 in comparison to the control group. It was also detected that serum SOD, glutathione peroxidase and nitric oxide (NO) levels were significantly higher in group 2 when compared to the control group (P<0.05). In the pathologic evaluation, group 2 showed significantly increased inflammation and fibrosis compared to the control group. Omega-3 treatment significantly decreased inflammation. It was shown that IFN α-2b application partially decreased inflammation.

INTERPRETATION & CONCLUSIONS

The results of the present study showed that in addition to the standard primary approaches to prevent the damage to the upper urinary tract secondary to PBOO, omega-3 fatty acid and IFN α-2b could be beneficial as adjunct treatment in clinical practice. However, this needs to be further investigated with prospective, randomized clinical trials with larger sample sizes.

Which method is the most effective for preventing postoperative infection in spinal surgery?

BACKGROUND

Several methods have been used to reduce the infection rate in spinal surgeries with instrumentation.

PURPOSE

Which method is the most effective for preventing postoperative infection?

STUDY DESIGN

Basic science, animal model.

OBJECTIVE

In the present study, the efficiency of antibiotic prophylaxis, silver-plated screws, and local rifamycin application to the surgical site was investigated in an experimental animal model. Staphylococcus aureus was used as the pathogen.

METHODS

Fifty 6-month-old female Wistar albino rats were used. The animals were randomly numbered and divided into five groups of ten rats each (Group 1, control group; Group 2, titanium screw and S. aureus inoculation; Group 3, titanium screw, 0.1 ml rifamycin application to the surgical area, and bacterial inoculation; Group 4, titanium screw, single preoperative dose of IM cefazolin, and bacterial inoculation; Group 5, silver-plated screw and bacterial inoculation). Titanium micro-screws were placed into the pedicles. The control group received a sterile isotonic solution, and the other four groups received bacterial suspensions containing S. aureus. The animals were killed 15 days later.

RESULTS

Intensive S. aureus growth was observed in all tissue and screw samples from Group 2. The results for Group 3 were similar to those for Group 1, no growth was observed in the screw cultures. Intensive growth was observed in the five screw samples in Group 4 and in the eight samples in Group 5.

CONCLUSION

Our study suggests that rifamycin application to the surgical area in spinal operations with instrumentation is an effective method to prevent S. aureus infections.

The effects of carvedilol on ischemia-reperfusion injury in the rat testis

OBJECTIVE

To analyze the oxidative damage and histopathological alterations caused by ischemia-reperfusion (I/R) injury and ameliorative effects of carvedilol (CVD) in the rat testis.

MATERIALS AND METHODS

Twenty-one male rats were randomized into 3 groups as follows: Group I (n = 7); control (sham) group, Group II (n = 7); I/R group, in which I/R injury was performed by torsing the left testis 720 ° clockwise for 2 hours and detorsing for 2 hours. Group III (n = 7); CVD treatment group; in addition to I/R process, one-dose of CVD was administered (2mg/kg, i.p) 30 min. before detorsion. Levels of antioxidant enzymes, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) and levels of malondialdehyde (MDA) and protein carbonyl (PC) were determined in testicular tissues and serum of rats. Testicular tissues were also examined histopathologically and Johnsen scores were determined.

RESULTS

Activities of SOD and GSH-Px in serum and testicular tissues were increased by I/R, but administration of CVD decreased these levels (p < 0.001 and p = 0.001). Significantly increased MDA levels in serum and testicular tissues were decreased by CVD treatment (p < 0.001 and p = 0.001). Concerning PC levels in serum and testicular tissues, there was no statistically significant difference between the groups (p = 0.989 and p = 0.428). There was not a statistically significant difference in terms of mean Johnsen scores between the groups (p = 0.161).

CONCLUSIONS

Administration of CVD decreased oxidative damage biochemically in the rat testis caused by I/R injury, but histopathologically no change was observed betwe¬en all of the groups.

The effects of trimetazidine and sildenafil on bilateral cavernosal nerve injury induced oxidative damage and cavernosal fibrosis in rats

AIM

The aim of this study was to compare the effects of sildenafil and trimetazidine on bilateral cavernosal nerve injury-induced oxidative damage and fibrotic changes in cavernosal tissue in rat model.

MATERIAL AND METHODS

A total of 32 male Sprague-Dawley rats were randomly divided into 4 groups; each group consist 8 rats (control, BCI, BCI + TMZ, and BCI + sildenafil groups). Tissue superoxide dismutase (SOD), malondialdehyde (MDA), and protein carbonyl (PC) levels were determined biochemically and distribution of cavernosal fibrosis density among groups was performed histopathologically.

RESULTS

Tissue SOD levels in BCI group were significantly lower than the control group (P < 0.05). Tissue MDA and PC levels in BCI group were significantly higher than the control group (P < 0.05). TMZ and sildenafil administration significantly increased tissue SOD levels (P < 0.05) and reduced tissue MDA and PC levels (P < 0.05). Histologically, the degree of cavernosal fibrosis and collagen density was higher in BCI group in comparison to control, TMZ-treated, and sildenafil-treated groups.

CONCLUSION

BCI caused oxidative damage and increased cavernosal fibrosis in rat penis. TMZ and sildenafil treatment decreased oxidative damage and reduced the degree of fibrosis in penile tissue due to BCI.

Loofah sponge as an interface dressing material in negative pressure wound therapy: results of an in vivo study

Since the introduction of negative pressure wound therapy (NPWT), the physiological effects of various interface dressing materials have been studied. The purpose of this experimental study was to compare the use of loofah sponge to standard polyurethane foam or a cotton gauze sponge. Three wounds, each measuring 3 cm x 3 cm, were created by full-thickness skin excision on the dorsal sides of 24 New Zealand adult white rabbits. The rabbits were randomly divided into four groups of six rabbits each. In group 1 (control), conventional saline-moistened gauze dressing was provided and changed at daily intervals. The remaining groups were provided NPWT dressings at -125 mm Hg continuous pressure. This dressing was changed every 3 days for 9 days; group 2 was provided polyurethane foam, group 3 had conventional saline-soaked antimicrobial gauze, and group 4 had loofah sponge. Wound area measurements and histological findings (inflammation, granulation tissue, neovascularization, and reepithelialization) were analyzed on days 3, 6, and 9. Wound area measurements at these intervals were significantly different between the control group and study groups (P<0.05). Granulation and neovascularization scores were also significantly different between the control and treatment groups at day 3 (P=0.002). No differences in any of the healing variables studied were observed between the other three dressing materials. According to scanning electron microscopy analysis of the three interface materials, the mean pore size diameter of foam and gauze interface materials was 415.80±217.58 μm and 912.33±116.88 μm, respectively. The pore architecture of foam was much more regular than that of gauze. The average pore size diameter of loofah sponge was 736.83±23.01 μm; pores were hierarchically located--ie, the smaller ones were usually peripheral and larger ones werecentral. For this study, the central part of loofah sponge was discarded to achieve a more homogenous structure of interface material. Loofah sponge study results were similar to those using gauze or foam, but the purchase price of loofah sponge is lower than that of currently available interface dressings. More experimental, randomized controlled studies are needed to confirm these results.

Tularemia in differential diagnosis of cervical lymphadenopathy: cytologic features of tularemia lymphadenitis

OBJECTIVE

Tularemia can cause cervical lymphadenopathy. Fine-needle aspiration (FNA) cytology is the first step in the workup for cervical lymphadenopathy; however, little has been published regarding the cytomorphological features of tularemia lymphadenitis. The aim of this study was to evaluate the FNA cytology of tularemia lymphadenitis.

STUDY DESIGN

Review of medical records identified 36 patients with serologically proven tularemia, and who had undergone lymph node FNA. In each case, the original May-Grünwald-Giemsa-stained FNA smears from enlarged cervical lymph node were reevaluated.

RESULTS

Suppuration and cytolysis were frequent cytological findings. Twenty-three (63.8%) of the 36 cases were assessed as suppurative inflammation. In 10 of these cases (27.8% of the total), cytolysis was prominent. In 7 cases (19.4%) the smears featured microgranulomas as well as suppuration, and 2 of these (5.6%) also featured giant cells. In 1 case (2.8%), there was caseous necrosis. In 2 cases (5.6%), the cytopathological findings were consistent with reactive lymphoid hyperplasia. Three aspirates (8.3%) were inadequate for evaluation.

CONCLUSION

Cytopathological findings on FNA of tularemia lymphadenitis are nonspecific; however, in regions where tularemia is endemic, this disease should be considered in the differential diagnosis for suppurative lymphadenitis.

Weight loss and melatonin reduce obesity-induced oxidative damage in rat testis

Aim. We aimed to evaluate the antioxidant effects of weight loss and melatonin on the obesity-induced oxidative damage in rat testes. Materials and Methods. 28 male Wistar albino rats were randomly divided into 4 groups, each consisting of 7 rats: control group (Group 1), obesity group (Group 2), obesity + MLT group (Group 3), and weight loss group (Group 4). Rats were weighed at the beginning and at the end of the study. Bilateral orchiectomy was performed and 5 cc blood samples were obtained from all of the rats. Superoxide dismutase (SOD), malondialdehyde (MDA), and protein carbonyl (PC) levels were analysed in the testicular tissues and serum. Spermatogenesis was evaluated with the Johnsen scoring system. Results. The testicular tissue and serum levels of MDA, PC, and SOD activity were increased in the obesity group in comparison to the sham operated group (P < 0.05). Weight loss and melatonin treatment ameliorated MDA, PC, and SOD levels in testicular tissue and serum significantly (P < 0.05). There was no significant difference between groups in terms of mean Johnsen score (P = 0.727). Conclusion. Experimentally created obesity caused oxidative stress and both melatonin and weight loss reduced oxidative stress parameters in rat testes.

[The effect of diet induced obesity on testicular tissue and serum oxidative stress parameters]

OBJECTIVE

The aim of this study was to evaluate the effects of diet induced obesity on semen parameters and serum antioxidant enzyme levels.

MATERIAL AND METHODS

Six-week-old male rats were randomized into three groups are as follows: group 1 (n=10) received a control diet, group 2 (n=9) received a high-fat diet and group 3 (n=11) received high-fat diet plus anastrozole. At the completion of a 10-week period, testicular tissues were obtained and spermatogenesis was evaluated with Johnsen Score System. The normal Johnsen Score was accepted as >9.39. In addition, serum antioxidant enzyme levels, triglyceride, cholesterol, testosterone, luteinizing hormone (LH), follicle stimilating hormone (FSH) and estradiol levels were measured in serum.

RESULTS

Body weight were significantly increased in mice fed with a high-fat diet compared to normal diet (P<.05). The mean triglyceride levels was 64.00±20.48 mg/dl, 98.89±27.80 mg/dl and 95.27±15.02 mg/dl in group 1, group 2 and group 3, respectively (P<.05). Male rats fed with a high-fat diet had significantly lower levels of testosterone compared with the control diet male rats (P=.005). Testicular pathology revealed that Johnsen Score System were 9.60±0.15, 8.72±1.81 and 9.29 in group 1, group 2 and group 3, respectively (P=.169). In addition serum nitric oxide (NO) levels were higher in group 2 and group 3 compared to group 1 (P<.05).

CONCLUSION

As a result it may be concluded that obesity may induce oxidative stress and decrease testosterone levels. These changes may alter testicular functions and consequently it may be speculated that obesity can be important causative factor in the etiology of the male infertility.

Schwannoma of the conus medullaris: a rare case

Intradural schwannoma of the conus medullaris is a rare form of spinal neoplasm, which commonly occurs in the lumbar region. Conus medullaris level is unusual for schwannomas. A 49-year-old woman presented with chronic sciatica, mild bladder dysfunction, and paresthesia in the buttocks. Magnetic resonance imaging of the spine showed a mass lesion in the conus medullaris region with nerve compression. The tumor was completely resected and diagnosed histologically as schwannoma. The patient recovered after surgery. Clinical and radiologic features of this rare tumor are reviewed and are accompanied by literature findings.